An Investigation Into the Etiology of Irritable Hip

Abstract

A prospective review has been made of 111 children who presented with acute hip pain to determine it's etiology and assess the need for multiple investigations at presentation. There was no clinical hematological, serological or bacteriological evidence to identify positively patients with an irritable hip, neither was there good correlation with a history of infection. An effusion was diagnosed by ultrasound in 71% but there were no factors, either clinically or by investigation, to differentiate between patients with or without an effusion. We conclude that multiple investigations to find a source of infection in patients with irritable hip are not warranted as they are rarely positive, seldom affect management and are of no help in investigating the etiology of irritable hip.

Management of irritable hip: a review of hospital admission policy.

“…The length of time that symptoms were reported before admission ranged widely in each group, with an average in patients withirritable hip of 4*1 days compared with 5 :onsidered of no of patients with irritable hip (mean the groups. It is 10-9 mm/h) and 95% of the group with sepsis average length (mean 53 9 mm/h).…”

“…-5 It was first described by Lovett and Morse in 1892 and subsequent work has further characterised the disorder. [1][2][3][4][5][6][7][8][9][10] Despite the efforts of several groups working prospectively, its aetiology remains obscure and no investigation has proved diagnostic.5 [11][12][13][14][15] It is apparent from published work that it is a self limiting disorder of variable severity, and there is little evidence that it results in any long term adverse effects. In the only three long term studies published, a slightly higher likelihood of coxa magna (radiological enlargement of the femoral head) was shown, though the number of cases was small and the significance uncertain.7 8 16 It is agreed that whatever its pathology, the danger when treating irritable hip is that of confusing it with a more serious disorder such as septic arthritis, Perthes' disease, late presenting congenital hip dysplasia, or slipped femoral epiphysis, thus delaying appropriate and timely treatment.…”

Lyme Arthritis Presenting as Transient Synovitis of the Hip

“…1 Although a number of infectious agents have been implicated as a cause of transient synovitis, the etiology remains unknown. 1,2 Lyme arthritis in children is characterized by brief, often recurrent attacks of oligoarthritis. 3 Although the knee is involved in 90% of children with Lyme arthritis, hip involvement is unusual.…”

Evaluation of causes of acute hip pain in children at Erbil teaching hospital

“…Various strategies for the work-up of children with hip pain have been proposed, some of them were based on clinical signs and laboratory parameters (3,4) while others relied more on medical imaging and aspiration of the hip joint (2)(3)(4)(5)(6)(7)(8)(9) . Imaging was usually performed with ultrasound and radiography.…”

“…Imaging was usually performed with ultrasound and radiography. Other modalities, such as bone scintigraphy, computed tomography, and magnetic resonance imaging, although were used by some authors (10) , were not routinely used for primary evaluation of painful hips (5,6,11) .…”